Focus on the person

Transition social workers need to understand the plans, concerns and needs of the young people and the families they support, and work with them to make those plans real.

Challenges we face

Lack of time and lack of trustOpen

In our consultation work on this project, we heard from young people and their families about social workers who engaged with them too late in the transition process. This in part explained why the social workers then seemed unable to work with them in a person-centred way, focusing on the young person’s strengths and aspirations. Without sufficient time to get to know a young person and their family, and to develop a trusting relationship, and without therefore the time to try things out, or put together really bespoke support for people, social workers too often, we heard, fall back on standardised, unimaginative packages of support.

These packages are often more costly than tailored alternatives. We heard how, without adequate, timely support, families are left to research things for themselves, and devise their own post-school package. If that costs, as some do, £150,000 a year, and at the last minute a duty social worker comes along and suggests something else – something cheaper – it is very hard for the family not to perceive that as inadequate. Without the time to develop trust, and really get to know a family, it is difficult to build in strengths-based work, and to try out various options.
Limited decision-making opportunitiesOpen

Trying out options is important. Young people with learning disabilities may not have been given much opportunity to make significant life decisions, and as they start to prepare for adulthood they – like any adolescent – need to be supported to make decisions.

Particularly where people’s cognitive impairments may make it more difficult to imagine concepts in the abstract, experimenting with things – actually doing them and seeing if the young person likes them – is a key way of supporting good decision-making. Without this, we risk denying people opportunities, while falling short of our own duties to properly implement the Care Act and the Mental Capacity Act.
Low aspirationsOpen

As well as often having been excluded from decision-making opportunities, young people with learning disabilities still at times grow up in an environment of low aspirations, in which it is assumed they will not get paid work, not have relationships and families, and not live as independently as possible. This unambitious stance can be found in schools and colleges, among professionals and even in families themselves, and all of this can feed a self-perception among young people that ends up limiting their options.

Social workers – the people charged with supporting young people towards the best adulthood they can have – should not feed into a context which limits people’s options, but we know that sometimes they do.
Eligibility and financial constraintsOpen

Financial considerations are one of the factors that may limit people. Local authority cuts are significant, and genuinely challenging to manage. They have created an environment in some areas in which budgetary considerations weigh heavily on decision-making, sometimes at the expense of young people’s aspirations, or even Care Act duties to promote an individual’s wellbeing.

Duties under the Care Act point to another challenge. The legal duty under the Act is, for each given eligible need a person has, to address it to the extent that it no longer has a significant impact on a person’s wellbeing, and this contrasts with the language of dreams and aspirations which is widely used in planning tools. Meeting the legal duty – relatively limited and specific as it is – can therefore result in an offer which may contribute to a sense of frustration and disappointment with service provision.

Making it better

No social worker can function at their best in poorly-functioning systems: practitioners need, as we have seen in Right conditions, basic structures in place in order to do their job properly. As professionals, they need to ensure they are aware of the law, policies and theories which shape their work supporting young people as they prepare for adulthood. This knowledge is one of the building blocks towards practising confidently, with a firmly-held set of values dedicated to promoting the rights and independence of young people. Advocating for people at funding panels, in large meetings or in discussions with their family members depends on this confidence, so that people can be supported effectively through occasionally baffling systems.

What young people and families we spoke to said they want in a social worker:

kind
understandable
respectful and polite
patient
confident
friendly
experienced
caring
good listener
knowledgeable
calm
on time

The structures, knowledge and values which feed into a social worker’s practice must all support and inform the one-to-one interaction between the social worker and the young person with whom they are working, in what needs to be an open, human, professional interaction between two people. In this, each brings their expertise to the relationship.

We have looked in some detail in other sections at the systems in place to support young people – or sometimes unintentionally to thwart them – and the role social workers have in joining them up, or in helping young people steer a course through them. Each section, and this one in particular, also looks at the social worker getting their own practice right. Without that, a smooth transfer from children’s to adults’ services means nothing; good quality practice both prior to, and after, any transition is vital. And that depends as much as anything on the quality of the relationship between the social worker and the young person.

Developing the relationshipOpen

That relationship, like any other, will need time to develop. This means social workers will need to engage with people early in the process of preparing for adulthood. Guidance suggests adult social care should be present at Year 9 school reviews for people with an EHCP, and yet this target is often missed. There are also implications for social workers having manageable caseloads so that they can spend a decent amount of time with each person with whom they are working, as we saw in Right conditions.

This message was at the heart of the NSW pilots. Speaking to social workers who took part in the pilots, the quality of the relationship was a recurring theme. One, from Halton Council, described working with a young woman engaging in risky behaviours: ‘I felt I really knew her. I was privileged to be able to have the connection with her and not just be working through a process. It was a real connection.’ They shared how that bond enabled the two of them to address the issues underlying the risks she was taking. But the social worker also recognised that to work well all the time, a smaller caseload would need to be in place.
A supportive relationshipOpen

Time will give people the space they need to get to know and trust each other, and from there to try out creative, person-centred approaches. Time will enable social workers to do more than rush through a prescribed series of tasks – to develop, as the NSW work put it – a relational approach to social work, rather than a simply transactional one.

What this means is recognising that social work is about more than completing key forms, such as the assessment and the care plan, creating a support package, closing the case and moving on. It is about allowing a social worker to stick around as a genuine support to a young person and their family as they navigate adolescence, a new set of services, and a new set of hopes and expectations.

This will allow space for the different perspectives in the relationship – of the young person, of the family and of the social worker – to be understood, worked through and where necessary compromised upon. This way, young people and their families can become more involved in planning for adulthood, and be much more in control of the process.
Planning Open

However a young person wants to be involved, support will need to be offered. Issues such as choosing a college, any limitations of what is on offer and the respective roles of all the new people in a young person’s life – all these and more will need to be explained. How that is done will depend on the wishes and needs of the young person, but all social workers should have the communication skills to engage with people in the ways that suit them best.

Help will be at hand. The person themselves, family members and other professionals can all work with the social worker to devise the best methods to work in a person-centred way with each individual, and there is a wealth of person-centred planning tools available. The message from the NSW pilots, and the engagement work from this project, however, is that any tool can only complement the relationship between worker, young person and family.
Cost savingsOpen

This approach takes time, and time, like money, is a scarce resource. But the NSW pilot work demonstrated genuine potential to save money by engaging in a more meaningful way with people with learning disabilities. A predictive economic analysis of the pilots, by York Consulting, tentatively suggests that £5.14 could be saved for every £1 invested in an NSW approach. This potential level of financial return on investment (FROI) demonstrates at least that committing resources to better social work relationships can lead to healthier budgets as well as better outcomes.
Dreams vs dutiesOpen

In any case, what young people want is typically not an expensive social care service, and it is typically not unrealistic. The messages we heard mirror what everyone hears who asks: young people with learning disabilities want support with friendships and relationships, work, a place to live, leisure and hobbies, and getting around. We do need to consider the tension between what a local authority is actually legally obliged to do, and the whole notion of dreams and aspirations. But often the two are not incompatible: the aspirations are actually for what a local authority by law needs to provide, and in any case a local authority is only ever meant to be one source of support.

A social worker should be able to explain not only what they can do, but also how other people, other agencies and the wider community can help. This may mean sharing success stories, introducing families to people who have been through the process, and other methods to foster ambition.

Top tips

Get to know people early: from the Year 9 school review.
Have sufficient time to build trusting relationships.
Try creative and person-centred approaches.
Focus on the relational, not the transactional, aspects of social work.
Develop mechanisms to allow young people and their families to be more involved in planning.
Look for opportunities to demonstrate that investing in time can save money.
Foster ambition. Share success stories.

Timeline

Crucially important in getting to know a young person, and supporting them in their plans for adulthood, is getting involved with them early enough for a relationship to develop. The statutory guidance under the Care Act requires adult social care to do certain things at certain key staging posts in a young person’s life.

Year 9 (ages 13–14)

Attend the annual school review: all partners in a child’s EHCP should attend at Year 9 to discuss plans for adulthood.

Years 10 & 11 (ages 14–16)

Adult social care/transition staff should ideally attend subsequent school reviews, so relationships can be developed and changing needs tracked. Regular meetings can help introduce topics like the Mental Capacity Act, which applies from 16 onwards.

Years 12 & 13 (ages 17–19)

Adult social care must assess any young person where it appears likely that they will have care and support needs in adulthood. Rather than at a specific point in time, this assessment – which can be requested by the young person, their family or any professional – should occur when it is of ‘significant benefit’ to the young person. This will typically mean in enough time for a decent adult care package to be put in place prior to the person’s eighteenth birthday. The Care Act requires that there is no gap in services between children’s and adults’ provision.

In many cases, the assessment will lead to a care package which will form the care element of an EHCP, so social workers will need to work alongside education and health partners.

Ages 19–25

If a young person remains in education until they are 25, an EHCP is likely to remain in place throughout that time. Otherwise, the young adult will be supported by social care, in partnership with other agencies, just as they would in other parts of the adult social care system. Local policy will determine which adult social care team people are supported in, and at what age they transfer to that team.

A personal story

Stuart was almost 18 years old when he was referred from children’s to adults’ services as part of the transitions process. He had profound complex health and social care needs, and no verbal communication. Stuart lived with his mother and his younger brother, who had no disabilities. Children’s services reported concerns of alleged neglect of Stuart, but had not instigated any child protection proceedings. The relationship between the children’s services social worker and Stuart’s mother had completely broken down, with a lack of trust and confidence on both sides.

The children’s services social worker was strongly advocating that adult social care should take immediate action via the Court of Protection to protect Stuart from significant harm. An urgent safeguarding meeting was held, and as part of this process the chair wrote to the health professionals involved in supporting Stuart, to seek evidence of the alleged significant harm and to gather information to manage any risks. Stuart’s mother was offered a carer’s assessment; this had not been previously offered to her within children’s services.

The carer’s assessment captured 18 years of emotional distress that Stuart’s mother had experienced caring for her son, starting from the point of birth when she found out Stuart was profoundly disabled. Her marriage had ended when Stuart was very young, and she was doing the best she could in raising her two sons on her own, while working in a part-time job. The social worker recorded how Stuart’s mother ‘shed 18 years of tears’, having been properly listened to by social services for the first time.

Stuart was offered person-centred planning sessions, where it was established that he liked racing cars; that the three people who were really important to him were his mother, father and brother; and that he had a really good sense of humour. This was communicated non-verbally via Stuart’s preferred communication format. Building on the results of the person-centred planning, and the positive relationship she had formed with Stuart and his family, the adult social worker determined to do everything she could to support the family to stay together while ensuring Stuart’s safety and wellbeing.

Stuart’s care and support needs were assessed and adaptations to the property were carried out. The needs of Stuart’s mother were also assessed, to enable her to continue her caring role, enjoy a better quality of life and sustain her employment. Some of Stuart’s many health appointments were amalgamated to reduce the time that his mother needed to take off work, as her inability to manage all of his appointments had led some of the concerns of alleged neglect. The care and support provided to Stuart also assured the local authority that Stuart’s needs were being met appropriately and safely.

Because a social worker spent proper time with Stuart and his family as he made the transition to adult services, Stuart was safeguarded both from the neglect at home, but also from the risk of a heavy-handed intervention that may have separated him from those he loved most. Stuart still lives with his mother in the family home, where he continues to thrive.